Early Psoriatic Arthritis | YMyHealth

Did you know that people who experience the red, itchy and scaly patches of the skin condition, psoriasis, can also have pain in their joints?

Together, it’s an autoimmune disease known as psoriatic arthritis, and its most commonly diagnosed in people ages 30-50.

Typically, the psoriasis appears years before the arthritis (joint pain) does.

While there is no cure for this condition that affects millennials, there are many different options to manage it. So, after receiving proper treatment you can still ‘live your best life’.

Diana Girnita, MD, PhD, of Rheumatologist OnCall specializes in treating patients with psoriatic arthritis and other rheumatic and autoimmune conditions. She shares with us how millennial-aged patients’ symptoms appear, the valuable role exercise can play, impacts on fertility and pregnancy, and complementary approaches to management, including the value of specific supplements.

Understanding psoriatic arthritis in younger patients

Psoriatic arthritis can be a tricky condition to catch, especially in younger patients like millennials.

“Most of these patients have psoriasis in the scalp, behind the ears—very classic areas—elbows, knees, umbilical areas, sometimes in the genital areas. When it's so hidden, patients will not tell you about the fact that they do have psoriasis,” Girnita said. “The skin disease can come and go. So, many times patients do not correlate the disease of the skin with the joint pain, making the diagnosis even harder.”

Yet, there are certain patterns a trained healthcare provider will always recognize. Girnita has seen patients come in with pain in their hands, wrists, or elbows . It can also affect their spine or cause pain in the lower back and buttocks. Some people even develop recurrent episodes of plantar fasciitis or tendonitis in the Achilles or presenting as golfer’s or tennis elbow. And here's a medical curveball - it can sometimes cause eye inflammation too.

That's why it's so important to pay attention to the type of pain you have and not brush it off if it’s persistent.

“If you are a millennial, you should not have pain, especially when you wake up in the morning,” Girnita emphasized. “You might have some soreness of the muscles or soreness from joint pain if you work out, if you have a physical job, but you should not have pain when you wake up in the morning, and you should not feel stiff. That's the difference between an inflammatory type of pain and degenerative type of pain.”

Sadly, it is common for her to see patients who have been living with skin and joint symptoms for at least a decade before getting proper treatment.

Getting diagnosed early is crucial because psoriatic arthritis can cause joint damage if left untreated, there is no undoing it.

“Psoriatic arthritis can be mild, but can also be very severe, and in some cases, quite debilitating. If you don't treat that, if you don't stop the disease, not only are you going to let those joints be damaged, but you will let the door open for chronic pain,” Girnita said. “With the right treatment, we can stop the disease from progressing.”

But as we all know, finding the time to go to a doctor’s appointment is a challenge for busy on-the-go millennials.

“I have a solution for that, and I think millennials are more open to this solution, Girnita said. “You don't have to always take the time away from work. You can use telemedicine to get a consultation from a physician.”

So, if you're noticing persistent joint pain or stiffness, don't wait. Reach out to a healthcare provider, even if it's through a virtual visit. Your future self will thank you.

Diana Girnita, MD, PhD, FACR, is the Founder of Rheumatologist OnCall®, a speaker, and author. She is double board-certified in rheumatology and internal medicine. She earned her MD and a PhD in immunology at Universitatea de Medicină și Farmacie din Craiova in Romania, where she grew up. She came to the United States as a PhD student and postdoctoral fellow at Harvard University.
She completed an internal medicine residency and rheumatology fellowship program at the University of Cincinnati.

Living with psoriatic arthritis: The millennial experience

One of the reasons for that gratitude from getting care is that that life with psoriatic arthritis as a millennial is not just about dealing with physical pain - this condition can impact every aspect of your life—your career, relationships, and even your mental health.

Imagine trying to climb the career ladder while battling chronic pain and fatigue. It’s exceptionally difficult. And when you're in your prime family-building years, psoriatic arthritis can add an extra layer of complexity to your decisions about starting or expanding your family. Plus, let's be real - being in constant pain isn't exactly conducive to maintaining a thriving social life or romantic relationship.

The emotional toll of all of this can make you feel frustrated, anxious, or even depressed. “That's why I encourage people to get the help that they need as soon as possible, because that will change how they will be able to perform in their life, and how they be able to be there for their families,” she said.

Girnita recommends millennials take to heart these effective coping strategies:

1) Be proactive about finding a medical provider who fits your needs. This is the most important thing you can do, she told us. Make sure it is a person who you can feel comfortable expressing your opinions to and talking about how treatment is affecting your life.

2) Stay informed. “Understand what you are going through,” she said. Learn about your treatment options, potential side effects, and the latest research.

3) Join support groups, like those offered by the Arthritis Foundation. Don't underestimate the power of connecting with others. It can be incredibly valuable to hear about other people’s experiences and it can give you new perspectives and coping strategies.

4) Stay positive. There are lots of treatment options. “Not all medications will cause side effects. With the right support you will have the chance to change things if they don’t work for you,” she said.

Lifestyle considerations for millennials with psoriatic arthritis

When you think about a condition like psoriatic arthritis you would think that there are restrictions on exercise because of the impact of sweat on skin and the potential for overuse of joints. Actually, it’s the total opposite.

“I highly recommend to my people with psoriatic arthritis and rheumatoid arthritis to engage in any activity that they love and enjoy, even if it's walking, dancing, Pilates, yoga. I encourage them to continue to use their joints because the exercise that you are doing, will decrease stiffness and improve the flexibility of the joints. It's going to improve muscle strength because if you are in pain, your muscles will deteriorate,” Girnita said.

She points out how valuable exercise also is for your mental health. “I know that sometimes a chronic condition can decrease your mood, can make you very depressed because you are dealing with that. Exercise is proven to improve your mood.”

Many studies have also shown it strengthens your immune system. So, taking all of this into consideration, even though sweating might irritate your skin a little bit affecting your psoriasis, the benefits you get from exercise are much more important, she emphasized.

As for another important lifestyle factor, your nutrition. “Nutrition opens a window towards more opportunities, and in my YouTube channel, I do a lot of education about foods that you should incorporate, foods that you should avoid,” Girnita said.

The nutritional choices that are scientifically proven to be helpful in psoriatic arthritis she says are:

Removing sugar or sugary drinks from your list. Sugar will be highly inflammatory in some patients have psoriasis.
Removing gluten – Try for a few months to see if the skin improves. If so and you feel better, she recommends continuing on a gluten-free diet.
Removing processed foods – Not eating tons of meat, for example.
Removing everything that contains refined carbohydrates -- all the white pasta and white rice.
Do not drink a lot of alcohol, decreasing it or not drinking at all -- alcohol can inflame your gut and that in reverse, will cause more psoriasis.

Dr. Girnita explains how the immune system, digestive system, and our nutrition are related. She details an extensive list of foods that increase psoriatic arthritis symptoms, including inflammation. She provides alternatives to these foods and foods you should add to your list.

Fertility, pregnancy, and psoriatic arthritis

Another lifestyle factor of importance for millennials, specifically women, is how any condition will affect their fertility and health during pregnancy.

It’s something that Girnita talks about with young women all the time when she is putting them on medication. “I discuss with them their planning—if they have a family, if they have kids—because I want to understand where they are in their life process,” she said.

First off, she wants us to know that psoriatic arthritis does not affect your fertility. So, that is great news! However, the medications you are taking can affect your baby, even if they don’t affect you.

Some of the heavy hitters in psoriatic arthritis treatment, like methotrexate, are absolutely contraindicated when it comes to pregnancy. These meds can potentially harm your baby, so you need to stop them well in advance - we're talking at least three months before you even start trying to conceive.

It's super important to have this conversation with your doctor early on, even if pregnancy isn't on your immediate radar. You don't want to be caught off guard if your family planning timeline suddenly changes!

“There are some medications that we can use to replace those medications you cannot take during the pregnancy time, where there are medications that could be used during that time, in which you can stay on them if you were on them before,” Girnita said.

For example, Humira and Cimzia have been shown to be okay to continue taking during pregnancy, if you were already on them before. But keep in mind, she said, the research in this area is ongoing.

“Some of the newer biologics, like Taltz or Cosentyx , we just don't have enough data on yet to say for sure if they're safe during pregnancy time. So, at this point, it is recommended to stop those,” she explained.

The key takeaway here is that managing psoriatic arthritis during pregnancy requires some careful planning and close communication with your healthcare team. While your treatment plan might need to shift, you can keep your condition under control and keep your baby safe.

Managing treatment and costs

When it comes to treating psoriatic arthritis, there's a wide range of options available. However, it's true that some of the newer medications, especially biologics, can come with a high price tag - we're talking up to $100,000 a year in some cases.

Thankfully, not everyone needs these expensive treatments. “About 40% of patients will be able to respond well to medications that will be affordable. Even for those that they need biologic medications, in my practice I have resources that I can help them to afford them, getting them the same type of medication or something similar that will be the lower cost,” Girnita said.

The key is to have an open conversation with your doctor about your financial situation and insurance coverage. Many healthcare providers like Girnita can provide you with information on patient assistance programs, lower-cost alternatives, or other creative solutions.

“That's why I tell patients not to despair because there are options and with the right support you will have access to the treatment you need,” she said.

Complementary approaches and prevention

Scientifically proven supplements

Dietary supplements—products that contain vitamins, minerals, herbs or other ingredients that can supplement the diet—can play a role in psoriatic arthritis management, but only when properly guided by your rheumatologist and in combination with standard treatments.

Girnita has high standards for having a supplement being backed by scientific research before recommending it to a patient. She also points out that she never recommends patients start more than one supplement at once or take them all at one time, nor does she recommend all of them to every patient.

Each person’s condition is individualized, and some supplements can cause more harm than good. Again, why it is so important to only take supplements in partnership with your healthcare provider.

Girnita has found four scientifically proven supplements that have shown promising results in playing a role in reducing inflammation, pain, and swelling, and improving function and skin health in people with Psoriasis and Psoriatic arthritis. They are Vitamin D, Fish Oil/Omega-3 Fatty Acids, Tumeric, and Probiotics. To learn the details, check out her article on Rheumatologist OnCall blog here.

Integrating alternative medicine

Other alternatives to consider integrating into your psoriatic arthritis and talking with your doctor about are heat and cold therapy, and massage therapy.

Alternating heat and cold therapy can help with pain. Cold therapy is most helpful when the joints are actively swollen. According to the National Psoriasis Foundation, a massage given by a licensed massage therapist can help relax those stiff muscles around joints reducing pain.

Conclusion

Psoriatic arthritis can affect millennials’ lives both physically and emotionally. The longer it is left undiagnosed and untreated the more negatively it will impact your quality life, including permanently damaging your joints.

We are fortunate to live in a time where there are numerous treatment options in mainstream medicine and evidence-proven lifestyle behaviors—exercise and the foods we eat—that we can easily incorporate into our daily routines to reduce inflammation and improve psoriatic arthritis symptoms.

The key to all of this though starts with making an appointment with healthcare provider who you feel comfortable with to get properly diagnosed and have the guidance to effectively manage their symptoms, so they can live full active lives.

Remember, Girnita told us, “Do not label yourself with a disease because that disease is not everything that you represent. Don’t lose hope. Although, you may have challenges along the way, in my experience the majority of patients that get help with psoriatic arthritis in the right amount of time will get much better.”

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Early Psoriatic Arthritis: The Millennial Experience